Page 1 of 146
PEDIATRIC PRIMARY CARE PNCB EXAM NEWEST
2025 ACTUAL EXAM TEST BANK| COMPLETE REAL
EXAM QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS) ALREADY GRADED
A+ (MOST RECENT!!)
A 10 month old has had apparent abdominal pain for the past 4 hours.
During episodes of pain, the infant screams inconsolably and draws his
legs towards the abdomen, has vomited twice, but has had no diarrhea.
Between episodes the infant is calm and quiet. The MOST likely
diagnosis is:
A) Meckel's diverticulum
B) intussusception
C) acute appendicitis
D) acute gastroenteritis - Correct Answer -intussusception
Acute onset of abdominal pain requires immediate investigation. The
nurse practitioner must be able to distinguish between conditions that
can safely be managed at home and those requiring immediate referral.
Meckel's diverticulum usually involves painless rectal bleeding. Acute
appendicitis can occur in infants and must be considered in the
differential diagnosis. The pain history of acute appendicitis is usually
more continuous, and there is no palpable mass. Acute gastroenteritis
may involve intermittent pain and cramping, but more typically the child
appears ill, and vomiting and diarrhea play a more prominent role. The
pain of intussusception is very severe, with periods of well-being in
between. There is frequently vomiting, however stools initially are
normal. Later stools can be like red jelly in appearance. A sausage
shaped mass is frequently palpable in the right upper quadrant and aids
in diagnosis.
pg. 1
,Page 2 of 146
Emphasis on promoting healthy behavioral changes for the overweight
child should include which of the following?
A) establishing family goals
B) maintaining family holiday meal rituals
C) weighing child daily
D) using weight loss as a sign of success - Correct Answer -establishing
family goals
Effective weight loss planning and implementation need to involve the
entire family. Emphasis should be placed on family change and family
goals as children will copy their parents' behaviors. In addition, parents
have control over some aspects of the change process that can occur in
relation to goals and meals in the home. Daily weights are not
recommended, and weight loss should not be used as the measure of
success. Changing behaviors is a success by itself and should be
celebrated. New family and holiday rituals should be established for a
focus on non-food related events.
A 7 year old fell, injuring the right wrist. Radiographs of the wrist were
negative, and the child was treated for a moderate sprain and sent home
with a sling. Ten days later the child is still complaining of wrist pain
with point tenderness. Which should be the NEXT step in management?
A) discontinue use of the sling
B) order a bone scan
C) repeat wrist radiographs
D) refer to orthopedic surgeon - Correct Answer – C.
Early fractures and Salter I fractures can be missed initially; repeat films
10 to 14 days after an injury may be necessary to confirm the diagnosis
pg. 2
,Page 3 of 146
of a fracture. Because this child is still symptomatic with complaints of
pain and point tenderness after the fall, follow up radiographic studies
are indicated. Bone scanning is useful in diagnosing stress fractures, but
not appropriate in this situation with a history of a known injury. It is
likely that this is a simple fracture that will heal quickly with
immobilization, with no disruption to bone growth. If the follow-up
radiograph showed evidence of trauma to growth plates, a referral to an
orthopedic surgeon would then be appropriate.
A newborn fails the initial hearing screen by otoacoustic emissions.
Which method of testing provides the MOST accurate reassessment?
A) auditory brainstem response
B) behavioral observation audiometry
C) repeat otoacoustic emissions
D) visual reinforced audiometry - Correct Answer – A.
Auditory brainstem response (ABR) is minimally affected by external or
middle ear debris, and yields the lowest false positive rate. It is the best
choice after a positive otoacoustic emission test (OAE). Repeating the
OAE may continue to yield the same results. Because it is significantly
affected by outer and middle ear debris it is less accurate than the ABR
in detecting hearing loss. Behavioral observation audiometry assesses
auditory function and perception and is subject to examiner bias. Visual
reinforced audiometry is insensitive to unilateral hearing loss. The child
responds at softer levels. Further, hearing impaired infants achieve early
language milestones such as smiling, cooing and babbling at the normal
times, making behavioral interpretation less accurate.
Which is the preferred diagnostic test for a 2 day old who has spitting
and choking with feedings?
pg. 3
, Page 4 of 146
A) placement of an orogastric feeding tube with chest / abdominal
radiograph
B) barium swallow with small bowel follow through
C) CT of the esophagus and stomach with oral contrast
D) placement of a nasogastric feeding tube and fluoroscopic evaluation -
Correct Answer – A.
Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF)
is commonly diagnosed in the newborn period when an infant has
recurrent spitting and choking with feeds. The diagnostic test for EA is
the passage of an orogastric tube followed by radiologic imaging to
confirm coiling of the tube in the thoracic region. Upper GI studies are
often used to diagnose obstruction, intestinal malrotation, and intestinal
duplication. CT scan is not needed for diagnosis, nor is nasogastric tube
with fluoroscopy. Newborns are obligatory nose breathers so it is best
not to put the feeding tube in the nose.
An adolescent sustains a puncture wound in the sole of a foot after
stepping on a protruding nail. In addition to reviewing tetanus vaccine
status, the MOST appropriate INITIAL management is
A) debridement of epidermal edges.
B) wound probing for retained material.
C) initiation of prophylactic antibiotics.
D) superficial irrigation of the wound. - Correct Answer – D.
Initial management of puncture wounds includes superficial irrigation
with sterile saline and cleansing the area of foreign matter to prevent
tattooing of debris into the dermal layers. High pressure wound
irrigation as well as surgical debridement and wound probing may
damage tissue and push foreign objects and bacteria deeper into the
pg. 4
PEDIATRIC PRIMARY CARE PNCB EXAM NEWEST
2025 ACTUAL EXAM TEST BANK| COMPLETE REAL
EXAM QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS) ALREADY GRADED
A+ (MOST RECENT!!)
A 10 month old has had apparent abdominal pain for the past 4 hours.
During episodes of pain, the infant screams inconsolably and draws his
legs towards the abdomen, has vomited twice, but has had no diarrhea.
Between episodes the infant is calm and quiet. The MOST likely
diagnosis is:
A) Meckel's diverticulum
B) intussusception
C) acute appendicitis
D) acute gastroenteritis - Correct Answer -intussusception
Acute onset of abdominal pain requires immediate investigation. The
nurse practitioner must be able to distinguish between conditions that
can safely be managed at home and those requiring immediate referral.
Meckel's diverticulum usually involves painless rectal bleeding. Acute
appendicitis can occur in infants and must be considered in the
differential diagnosis. The pain history of acute appendicitis is usually
more continuous, and there is no palpable mass. Acute gastroenteritis
may involve intermittent pain and cramping, but more typically the child
appears ill, and vomiting and diarrhea play a more prominent role. The
pain of intussusception is very severe, with periods of well-being in
between. There is frequently vomiting, however stools initially are
normal. Later stools can be like red jelly in appearance. A sausage
shaped mass is frequently palpable in the right upper quadrant and aids
in diagnosis.
pg. 1
,Page 2 of 146
Emphasis on promoting healthy behavioral changes for the overweight
child should include which of the following?
A) establishing family goals
B) maintaining family holiday meal rituals
C) weighing child daily
D) using weight loss as a sign of success - Correct Answer -establishing
family goals
Effective weight loss planning and implementation need to involve the
entire family. Emphasis should be placed on family change and family
goals as children will copy their parents' behaviors. In addition, parents
have control over some aspects of the change process that can occur in
relation to goals and meals in the home. Daily weights are not
recommended, and weight loss should not be used as the measure of
success. Changing behaviors is a success by itself and should be
celebrated. New family and holiday rituals should be established for a
focus on non-food related events.
A 7 year old fell, injuring the right wrist. Radiographs of the wrist were
negative, and the child was treated for a moderate sprain and sent home
with a sling. Ten days later the child is still complaining of wrist pain
with point tenderness. Which should be the NEXT step in management?
A) discontinue use of the sling
B) order a bone scan
C) repeat wrist radiographs
D) refer to orthopedic surgeon - Correct Answer – C.
Early fractures and Salter I fractures can be missed initially; repeat films
10 to 14 days after an injury may be necessary to confirm the diagnosis
pg. 2
,Page 3 of 146
of a fracture. Because this child is still symptomatic with complaints of
pain and point tenderness after the fall, follow up radiographic studies
are indicated. Bone scanning is useful in diagnosing stress fractures, but
not appropriate in this situation with a history of a known injury. It is
likely that this is a simple fracture that will heal quickly with
immobilization, with no disruption to bone growth. If the follow-up
radiograph showed evidence of trauma to growth plates, a referral to an
orthopedic surgeon would then be appropriate.
A newborn fails the initial hearing screen by otoacoustic emissions.
Which method of testing provides the MOST accurate reassessment?
A) auditory brainstem response
B) behavioral observation audiometry
C) repeat otoacoustic emissions
D) visual reinforced audiometry - Correct Answer – A.
Auditory brainstem response (ABR) is minimally affected by external or
middle ear debris, and yields the lowest false positive rate. It is the best
choice after a positive otoacoustic emission test (OAE). Repeating the
OAE may continue to yield the same results. Because it is significantly
affected by outer and middle ear debris it is less accurate than the ABR
in detecting hearing loss. Behavioral observation audiometry assesses
auditory function and perception and is subject to examiner bias. Visual
reinforced audiometry is insensitive to unilateral hearing loss. The child
responds at softer levels. Further, hearing impaired infants achieve early
language milestones such as smiling, cooing and babbling at the normal
times, making behavioral interpretation less accurate.
Which is the preferred diagnostic test for a 2 day old who has spitting
and choking with feedings?
pg. 3
, Page 4 of 146
A) placement of an orogastric feeding tube with chest / abdominal
radiograph
B) barium swallow with small bowel follow through
C) CT of the esophagus and stomach with oral contrast
D) placement of a nasogastric feeding tube and fluoroscopic evaluation -
Correct Answer – A.
Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF)
is commonly diagnosed in the newborn period when an infant has
recurrent spitting and choking with feeds. The diagnostic test for EA is
the passage of an orogastric tube followed by radiologic imaging to
confirm coiling of the tube in the thoracic region. Upper GI studies are
often used to diagnose obstruction, intestinal malrotation, and intestinal
duplication. CT scan is not needed for diagnosis, nor is nasogastric tube
with fluoroscopy. Newborns are obligatory nose breathers so it is best
not to put the feeding tube in the nose.
An adolescent sustains a puncture wound in the sole of a foot after
stepping on a protruding nail. In addition to reviewing tetanus vaccine
status, the MOST appropriate INITIAL management is
A) debridement of epidermal edges.
B) wound probing for retained material.
C) initiation of prophylactic antibiotics.
D) superficial irrigation of the wound. - Correct Answer – D.
Initial management of puncture wounds includes superficial irrigation
with sterile saline and cleansing the area of foreign matter to prevent
tattooing of debris into the dermal layers. High pressure wound
irrigation as well as surgical debridement and wound probing may
damage tissue and push foreign objects and bacteria deeper into the
pg. 4
